Selma Blair’s recent in-flight arrest has raised questions about the potential effects when a person with multiple sclerosis misses prescribed medication.
The actress, 54, was arraigned Monday on two counts of second-degree assault after allegedly attacking a police officer and nurse following an altercation with flight attendants aboard a Delta flight into New York City, The Associated Press reported.
In court, Blair’s attorney, Shawn Barnes, said that Blair had missed several doses of Nuedexta, “a powerful medication that controls severe neurological symptoms,” according to multiple outlets.
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The attorney added that Blair hit her head during the flight, which departed from Los Angeles, and was in “a state of severe confusion and disorientation.” He also suggested the altitude may have been a factor.
The incident was the result of a “medical emergency” and not criminal misconduct, he claimed.
Blair was diagnosed with MS in 2018.
Fox News Digital reached out to Blair’s representatives requesting comment.
There are three primary treatment approaches for multiple sclerosis, according to Dr. Lee Murray, a board-certified neurologist practicing in Jackson, Tennessee, at West Tennessee Healthcare.
“The first-line treatments we utilize try to prevent recurrent inflammatory attacks,” Murray, who has not treated Blair, told Fox News Digital.
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These medications often involve IV infusions, but they can be in the form of pills or injections the patient gives themselves.
“These are oftentimes medications folks take for several years,” Murray said. “The hope of that is to keep the MS suppressed, to keep [the patient] from having MS attacks.”
When patients experience an MS relapse, doctors may prescribe high-dose steroids, either orally or intravenously, to reduce inflammation and help speed recovery, according to Cleveland Clinic.
Patients with multiple sclerosis often have other health issues, Murray noted.
“For instance, patients with MS may have bladder difficulties, or they’ll develop depression or neuropathic pain,” he said. “And so we prescribe medications that don’t treat the MS itself, but they deal with the symptoms related to MS.”
Dr. Yoshua Quinones, board-certified internist with Medical Offices of Manhattan, reiterated that there are different classes of MS medications.
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“Disease-modifying therapy reduces relapses, new MRI lesions and long-term disability accumulation,” Quinones, who also did not treat Blair, told Fox News Digital.
Other medications are used to treat acute relapses or manage symptoms such as fatigue, walking difficulties, spasticity and bladder problems.
Disease-modifying therapies themselves fall into several categories, according to the doctor.
Immunomodulators help regulate the immune system, while anti-trafficking drugs prevent certain immune cells from reaching the brain and spinal cord. Cell-depleting therapies, which are generally considered highly effective treatments, target and remove specific immune cells.
It’s essential for patients to be compliant with their MS medications, according to Murray.
“If an MS medication dosage is missed, the patient runs the risk of having an MS relapse, which can result in acute or new changes neurologically,” he said. “There’s a host of different symptoms that can occur.”
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Potential effects of a relapse may include balance difficulties, vision loss, dizziness, bowel or bladder dysfunction, or weakness, numbness or tingling on one side.
In Blair’s case, Murray said, “If the Nuedexta was being used to treat pseudobulbar palsy secondary to her MS, missed doses could result in uncontrolled crying or laughter and emotional lability (rapid or unpredictable changes in emotion or mood).”
“I have never seen a missed dose of Nuedexta cause physical aggression,” he added.
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If a patient with multiple sclerosis has missed doses of medication and begins to develop new neurological deficits, they should seek medical attention to determine whether they are in an active MS flare, the neurologist advised.
“Recognizing that and being able to quickly get on high-dose steroids can reverse some of the symptoms the patient may be experiencing,” he said.
Although steroids can speed recovery from an MS relapse, they have not been shown to improve long-term outcomes, according to the MS Society.
Quinones agreed that skipping medications will reduce disease control.
“Poor compliance will increase the risk of relapse and MS-related hospitalizations,” he said. “For example, if you stop any anti-trafficking medication, it carries a high risk of rapid disease reactivation. Abrupt cessation of this class can even trigger a rebound worse than baseline.”
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Cell-depleting agents can act over months, so a single missed or delayed dose is less immediately impactful, Quinones added.
“A single dose of disease-modifying therapy is not catastrophic — however, if constantly missed, it can raise a relapse risk.”
The risks of missing medication depend on the specific drug, how long treatment is interrupted and the patient’s individual circumstances, according to doctors.
Fox News’ Tracy Wright contributed reporting.
